Synovial chondromatosis of the hand: Three case reports and literature review

Synovial chondromatosis is a rare condition that is probably caused by synovial connective tissue metaplasia. It is very rare in the hand and wrist and because of its low prevalence and nonspecific symptoms, synovial chondromatosis can present diagnostic difficulties for the hand surgeon and may lead to a delay in treatment. We review the literature and report three additional cases of synovial chondromatosis in the hand.     

Diagnosis and Arthroscopic Treatment of Primary Synovial Chondromatosis of the Shoulder

Primary synovial chondromatosis of the shoulder is a rare condition. We present the case of a 24-year-old man with a 6-month history of right shoulder pain and decreased range of motion. Computed tomography and magnetic resonance imaging findings led us to the diagnosis of synovial chondromatosis of the shoulder. Arthroscopy revealed loose bodies in the glenohumeral joint, the biceps tendon sheath, and the subscapularis recess. Active intrasynovial proliferation of the axillary pouch was noted. All loose bodies were removed arthroscopically, and partial synovectomy was performed. Histologic examination confirmed the diagnosis of primary synovial chondromatosis. We recommend arthroscopic treatment for synovial chondromatosis of the shoulder because of low morbidity and early functional return.     

Synovial chondromatosis of the elbow

Synovial chondromatosis is an uncommon disorder with rare occurrence in the elbow. Case reports in the literature for elbow synovial chondromatosis have described presenting symptoms secondary to peripheral nerve compressions or localized bursitis. We discuss a case of synovial chondromatosis of the elbow that presented as an isolated soft-tissue mass over the radial head-more suggestive of a soft-tissue tumor than of synovial chondromatosis.     

Synovial chondromatosis in a facet joint of a cervical vertebra

STUDY DESIGN: A case report of a cervical facet joint synovial chondromatosis. OBJECTIVES: To correlate the radiologic and histologic features of vertebral synovial chondromatosis with review of the literature. SUMMARY OF BACKGROUND DATA: Only two previous cases of vertebral facet joint synovial chondromatosis were found in a review of the English language medical literature. METHODS: A 39-year-old woman had severe cervical pain associated with neurologic signs and symptoms in the left upper extremity. Computed tomographic and magnetic resonance imaging studies were performed. RESULTS: Imaging studies showed lytic defects in the laminae of C3 and C4, with intermediate T1 and high T2 signal intensities. The diagnostic impression was that of a lymphangioma or synovial cyst. A laminectomy showed synovial tissue in both the C3-C4 facet joint and the lamina bone. Histologic examination disclosed synovial chondromatosis. CONCLUSIONS: Synovial chondromatosis of the vertebral spine is quite rare, this being only the third reported example. Direct invasion of the cancellous bone, as in this case, also is a very uncommon feature of chondromatosis. It is emphasized that when radiologic studies demonstrate a lesion with cartilaginous characteristics within or juxtaposed to a joint, synovial chondromatosis, despite its rarity, should be included in the differential diagnosis, regardless of the anatomic site.     

New-Onset Synovial Chondromatosis After Total Knee Arthroplasty

Total joint arthroplasty is commonly recommended as a definitive treatment for synovial chondromatosis refractory to other treatment. We describe a unique case of synovial chondromatosis developing after total joint arthroplasty in a patient presenting 5 years after total knee arthroplasty for osteoarthritis. This case illustrates that the diagnosis of synovial chondromatosis cannot be excluded in a patient with chronic, painful swelling of a joint, even after total joint arthroplasty.     

Synovial chondromatosis of the metacarpophalangeal joint of the ring finger

Synovial chondromatosis is an uncommon condition, characterized by multinodular cartilagineous proliferation of the joint synovium. There are only a few case reports of synovial chondromatosis involving the hand in the literature. A case of synovial chondromatosis of the ring finger is reported in this paper.     

Vertebral synovial chondromatosis. Report of two cases and review of the literature

Synovial chondromatosis is an uncommon disorder characterized by the formation of multiple cartilaginous nodules within the synovium, most commonly affecting large joints. Its involvement with the spine is rare; only six cases have been reported. The authors describe two patients with synovial chondromatosis involving the cervical spine. In the first case, synovial chondromatosis arose from the left C1-2 facet joint. This patient underwent a two-stage procedure including a posterior approach for tumor resection and occipitocervical fusion as well as a transmandibular circumglossal approach to the anterior craniocervical junction to complete the tumor removal. Interestingly, on histopathological examination, scattered foci of low-grade chondrosarcoma were intermixed within the synovial chondromatosis. To the authors' knowledge, this is the first report of secondary low-grade chondrosarcoma arising in vertebral synovial chondromatosis. In the second case, synovial chondromatosis involved the left C4-5 facet joint. Tumor resection and cervical fusion were performed via a posterior approach. In this report, the authors describe the clinical presentation, radiographic findings, operative details, histopathological features, and clinicoradiological follow-up data obtained in these two patients and review the literature pertaining to this rare entity.     

Synovial chondromatosis of the metacarpophalangeal joint: case report and review of the literature

Intra-articular synovial chondromatosis in the hand is rare but should be considered in the differential diagnosis of a swollen, stiff or painful joint. Other possible diagnoses include osteoarthritis, rheumatoid arthritis, gout, trauma and chronic infection, and unless enchondral ossification of loose bodies is seen the diagnosis of synovial chondromatosis may not be made preoperatively. A 69-year-old man with synovial chondromatosis of the metacarpophalangeal joint is reported. The joint was swollen and tender. He had not sustained trauma and there was no evidence of arthritis, involvement of other joints or infection. Complete synovectomy with removal of all loose bodies was successful and his symptoms resolved. Intra-articular synovial chondromatosis is a benign condition, but spontaneous resolution is the exception and surgical synovectomy remains the most effective treatment.     

Recurrent synovial chondromatosis of the wrist: case report and literature review

Synovial chondromatosis of the wrist is rare. We report the case of a 35-year-old man with synovial chondromatosis of the left wrist with an 8-year follow-up. Frequent recurrences finally resulted in total wrist arthrodesis. A review of the literature produced 24 case reports of synovial chondromatosis of the wrist with only three cases showing recurrence.     

Giant synovial osteochondromatosis of the acromio-clavicular joint in a child. A case report and review of the literature

Primary intra-articular synovial chondromatosis represents an uncommon condition involving mainly the large joints predominantly of middle-aged adults. We herein document the first case of synovial chondromatosis affecting the acromio-clavicular joint of a 10-year-old girl, characterized by a solitary huge intra-articular osteochondromatous body (giant synovial chondromatosis) that had caused dislocation and deformation of the lateral portion of the clavicle. Successful surgical treatment consisted of removal of the osteochondral body and replacement of the clavicle by fixation with a K-wire.     

The role of arthroscopy in the management of synovial chondromatosis of the shoulder. A case report

A case of synovial chondromatosis of the shoulder is reported in a 28-year-old man with long-standing shoulder pain after a remote episode of trauma. Although plain roentgenograms were normal, arthrograms revealed the characteristic findings of synovial chondromatosis. Treatment consisted of arthroscopic removal of multiple cartilaginous loose bodies and partial synovectomy. Synovial chondromatosis of the shoulder treated with arthroscopic debridement and synovectomy rather than traditional open arthrotomy seems not to have been reported previously.     

Synovial chondromatosis of the elbow causing a mechanical block to range of motion: a case report and review of the literature

We report a unique case of elbow synovial chondromatosis with sudden onset of severe loss of elbow extension and flexion range of motion caused by mechanical block from deposition of chondral fragments in the olecranon and coronoid fossae, respectively. We performed successful arthroscopic surgical treatment of synovial chondromatosis of the elbow. Arthroscopy examination revealed an acutely evolving synovial chondromatosis. Three-year follow-up indicated that arthroscopic removal of loose bodies and partial synovectomy can yield lasting improvement in motion without disease recurrence.     

Synovial chondromatosis of the acromioclavicular joint

Summary Synovial chondromatosis involving the acromioclavicular joint is very rare. We report a case of synovial chondromatosis of the acromioclavicular joint associated with synovial cyst formation. Arthrography of the acromioclavicular joint revealed that the loose bodies lay within a synovial cyst which was in communication with the acromioclavicular joint. Synovectomy including removal of the synovial cyst and the loose bodies relieved symptoms completely. The patient was still pain- and recurrence-free at 4 years' follow-up.     

Synovial Chondromatosis of the Shoulder

Articular synovial chondromatosis is a rare disease commonly affecting the knee, hip or elbow, and characterised by the formation of metaplastic cartilaginous foci in the synovium. A case of synovial chondromatosis affecting the shoulder joint is now reported because of the extreme rarity of the disease in this situation.     

Giant solitary synovial chondromatosis of the temporomandibular joint with intracranial extension

Synovial chondromatosis are rare entities but are well-described lesions in the literature that can affect many joint areas of the body. A case of tumoral synovial chondromatosis involving the temporomandibular joint with intracranial extension through mandibular fossa is reported. As long as there was significant infratemporal and extradural invasion of the middle and posterior fossa, a transtemporal and infratemporal approach was performed and total removal of the lesions was achieved. A brief review of skull base synovial chondromatosis is presented.     

Giant Solitary Synovial Chondromatosis of the Temporomandibular Joint with Intracranial Extension

Synovial chondromatosis are rare entities but are well-described lesions in the literature that can affect many joint areas of the body. A case of tumoral synovial chondromatosis involving the temporomandibular joint with intracranial extension through mandibular fossa is reported. As long as there was significant infratemporal and extradural invasion of the middle and posterior fossa, a transtemporal and infratemporal approach was performed and total removal of the lesions was achieved. A brief review of skull base synovial chondromatosis is presented.     

Synovial Chondrosarcoma Arising in Synovial Chondromatosis of the Temporomandibular Joint

Synovial chondromatosis of the temporomandibular joint is rare. Even less commonly documented is the progression of synovial chondromatosis to a synovial chondrosarcoma. The aim of this paper is to present only the third case of synovial chondrosarcoma of the temporomandibular joint. Distinction between these two entities by histology alone is extremely difficult and even though it is advised that the definitive diagnosis should be based on clinical, radiographic and histological evidence, this has proved not to be so simple. The patient, a 63 year old female presented with a swelling associated with her left temporomandibular joint. CT and MRI scans confirmed the presence of a periauricular chondroid mass. Fine needle aspiration biopsy revealed an atypical chondroid lesion that was supicious for a chondrosarcoma. The left temporomandibular joint and surrounding tissues were resected after further imaging and extensive clinical, radiological and cytologic consultations. A diagnosis of synovial chondrosarcoma arising in synovial chondromatosis was made.     

Synovial chondromatosis of the metacarpophalangeal joint.

The authors present a case of synovial chondromatosis localized on the left hand of a woman and discuss the pathogenesis, history and treatment of the synovial chondromatosis. The patient has been free of complaints for the 2 years since the operation.     

Disseminated synovial chondromatosis of the knee treated by open radical synovectomy using combined anterior and posterior approaches

Synovial chondromatosis of the knee is a rare benign neoplasm of the synovium. Likewise, uncertainty on management still prevails. Though rare, it nevertheless warrants greater emphasis than it receives in the literature to allow correct diagnosis and accurate early surgical intervention. It predominantly involves the anterior compartment of the knee and disseminated disease is extremely rare. The optimal approach for surgical treatment of such an extensive synovial chondromatosis of knee remains unclear. Herein, we describe a case of extensive generalized synovial chondromatosis of the knee extending into the Baker''s cyst in a 30 years old female. A diagnosis of synovial chondromatosis was made by clinical evaluation and MR imaging and confirmed by histopathological examination. Patient was successfully treated by open radical synovectomy of knee using both anterior and posterior approaches in a single step procedure.     

Synovial chondromatosis of the shoulder associated with osteoarthritis: conservative treatment in two cases and review of the literature

Periarticular synovial chondromatosis associated with osteoarthrosis is a rare condition that is more frequently seen in the lower extremity than in the upper extremity. In patients who have synovial chondromatosis of the joints of the lower extremity and are symptomatic, the traditional method of treatment has included open or arthroscopic synovectomy and removal of loose bodies. In cases involving the upper extremity, especially in the shoulder, patients have variable disability and may be treated successfully without surgery. Two patients who presented to our practice with shoulder symptoms due to synovial chondromatosis were treated successfully without surgery. In both patients nonoperative treatment consisting of activity modification, nonsteroidal anti-inflammatory medication, and cryotherapy as needed led to a good result without surgical intervention.